Trauma month: pre-hospital care

Advanced trauma team

Major trauma makes up less than 5% of the entire workload of the ambulance service, meaning the average ambulance crew will only be exposed to a major trauma patient a couple of times a year.

Across the region we have enhanced care teams (ECTs), BASICs doctors and critical care paramedics (CCPs) available to assist in the treatment, triage and transport of the trauma patient and who deal with major trauma on a more regular basis.

Deploying specialist practitioners (CCPs and ECTs) with their regular training, advanced skills and additional equipment, is a pivotal addition to the treatment we can give patients. Much like any other service request such as fire or police, the request for CCPs and ECTs should be done every time a patient has suffered a major trauma, or indeed any injury recognised as requiring more advanced clinical care.

So it helps to remember the acronym below – which is not an official teaching guide but can help you:



Team Resource Management in any trauma job is vital. Take a step back. Ensure you are aware of the whole situation you are walking in to. Be aware of your colleagues, capabilities and the situation around you. Adorn PPE as necessary. Time is going to be of the essence and speed of delivery of care will be essential. 


Assessment. C, A, B (FLAPS TWELVE) C, D, E. Concise and confident.  


Update - those around you, CCD and/or EOC of the outcome of your   assessment, including trauma triage tool result: MTPOS/MTNEG.  


Make a decision. What does the patient need? Who else can help? Where do you need to go? How best and how long to get there?  


Action plan. Treatment, triage and transport.  

Here are some examples of the type of care that can be delivered by CCPs and ECTs which are all from real incidents in the last couple of months:

Incident type

Level of responder

Interventions provided

12-year-old fall   from a tree, angulated leg, femur fracture.  


Sedation with ketamine to facilitate pain free manipulation of the limb.

High speed RTC,   head injury, skull fractures


Midazolam sedation for hypoxic agitation and prophylactic abx for exposed skull fractures.  

Collapse 62-year-old male, cardiac arrest


QCPR, ALS, post   ROSC care including vasopressor support and sedation for awareness.  

High-speed trapped RTC, chest and head injuries

L3 medical team

Sedation prior to a full anaesthetic (RSI), chest decompression and triage by helimed to a major trauma centre.

Fall from height (four stories), traumatic cardiac arrest

EEAST CCP plus   L3 medical team

ALS, bi-lateral chest decompression by the CCP, ROSC, RSI by L3 team and triage to a major trauma centre by air.  


If in any doubt, or for some clinical support for your trauma patient, call the critical care desk which is available all of the time, by requesting speech on channel 202 or by calling 01245 444496. Another important balance is whether the time of awaiting a specialist resource creates more risk to the patient. It is also essential that while awaiting for specialist support we continue to provide appropriate treatment and interventions.

Published 14th May 2015 

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